Nasogastric Question

[SA2BDOCTOR]

Differentiate between nasogastric decompression and nasogastric enteral feeding

[shock-me-sane]

I think I am right. NG to gravity or low wall suction to remove stomach contents. Feeding is putting Jevity or Nephro as a source of nutrition.

[Daytonite, BSN, RN]

Here is a very nice article that talks about the various types of N/G tubes:

http://www.icufaqs.org/NGtubes.doc - N/G Tubes for Beginners

A nasogastric decompression tube is inserted into the stomach and can be advanced beyond the stomach and into the intestinal track for the purpose of aspirating intestinal contents, preventing abdominal distention after GI surgery and to treat intestinal obstruction. The type of tube chosen for decompression depends upon the size of the patient, the reason for the presence of the tube and the estimated length of the intubation. If the tube is going to be advanced beyond the stomach, it will usually be radiopaque so it's placement can be confirmed by x-ray. They can also be weighted with mercury to help the tube advance through the small intestine. These tubes are then attached to negative pressure suction devices, either portable or stationary and the suction can be applied intermittently or continuously. In the old days, doctors would write "N/G to low Gomco suction". Gomco was the name of the manufacturer of the portable suction machines that we used. It had two settings: low and high. We always used the low setting which was 80 mmHg of pressure. It cycled on and off automatically and drew air and fluid into a glass bottle in the Gomco unit. The bottle had an open port in the top of it's rubber stopper to let any air out, yet trap the drainage. We measured the level of drainage in the bottle at the end of each shift and recorded it on the patient's I&O record. Today, the Gomco has often been replaced by in wall units. The most commonly seen N/G tube in use is the Salem sump which has a distinctive blue pigtail which is open to atmospheric air. Complications that can occur with these kinds of tubes include:

• epigastric pain and vomiting
  
• perforation
  
• dehydration and electrolyte imbalances
  
• nasal skin breakdown and discomfort
  
• increased mucous secretions
  
• aspiration pneumonia
  
• damage of the gastric mucosa from suctioning
  
• aggravation of esophagitis, ulcers, or esophageal varices which can lead to hemorrhage
  
• parotitis which can occur in dehydrated and debilitated patients (symptoms include pain, swelling and salivary dysfunction)

The tubes that are used for tube feedings differ slightly than the ones used for decompression. In general, they are smaller in diameter to allow for comfort of the patient. The ends of the tubes may be in the stomach, duodenum or the jejunum. There are many different formulations of liquid feedings being manufactured and each has specific nutritious value and some have special considerations with regard to being given through a tube. Most of them require some sort of pump delivery, but not all.

It is important that you understand the importance of verifying the placement of a tube before inserting anything into it and know the complications that can occur with tube feedings:

• aspiration of gastric secretions
  
• obstruction of the tube
  
• oral, nasal or pharyngeal irritation or necrosis
  
• vomiting, bloating, diarrhea, cramps
  
• constipation
  
• electrolyte imbalances
  
• hyperglycemia